Correct Priority Research Articles

The treatment of patients with severe and multiple traumatic injuries.

The care of severely and multiply injured patients is an interdisciplinary challenge. The only existing German-language guideline up to now has been the S1-guideline issued in 2002 by the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). In this article, we present a new, comprehensive, evidence and consensus based S3-guideline for the treatment of severely and multiply injured patients in the pre-hospital and early in-hospital phases which has been developed with the aim of structural and procedural quality optimization. Its implementation should lower these patients' mortality and improve their quality of life. The guideline was developed by a panel consisting of 18 delegates from 11 specialty societies under the lead of the DGU, with designated coordinators for each of three phases of treatment: the pre-hospital phase, the emergency-room phase, and the emergency surgery phase. The key questions to be answered were determined by vote, and then the relevant literature (in English and German, 1995-2010) was systematically searched and evaluated. Key recommendations with explanatory texts were formulated and agreed upon in a nominal group process (NGP) with five consensus conferences and three further Delphi rounds. 264 recommendations were issued: 66 for the pre-hospital phase, 102 for the emergency-room phase, and 96 for the emergency surgery phase. The three phases were subcategorized according to organizational and anatomical considerations. Topics of major emphasis were, in the pre-hospital phase, the establishment and implementation of correct priorities for treatment; in the emergency-room phase, the creation of clear structures and processes; and, in the emergency surgery phase, the avoidance of secondary injury (i.e., the principle of damage control). This guideline can only improve outcomes if it is implemented in routine practice. Aside from the guideline itself, the DGU trauma network (www.dgu-traumanetzwerk.de) has issued a set of directions as an aid to its implementation.

Alliance for biomedical research in Europe

Europe is facing one of the most challenging times in its history, with austerity measures being applied across member states that are leaving research programmes in uncertain territory. Funding for European research and development (R&D) programmes remains stagnant at 1.8% of European Union GDP, well short of the 3.0% that was committed to in the Lisbon summit of 2002. This stagnation occurs while all of Europe's major competitors – namely the USA (2.7%), Japan (3.4%) and most recently China – continue to invest in their biomedical research programmes. UNESCO data from 2007 shows that China's total R&D investment was one third of that of the entire EU. But continued investment and rising GDP means that China's investment is likely to quadruple by 2020, meaning its total R&D spending will overtake Europe in a few years. European biomedical research could be left behind unless major steps are taken to address this gulf in funding. Yet it is not only how much money we receive, but how we spend that money, that has inspired the creation of the Alliance for Biomedical Research in Europe (Biomed Alliance) (see Box 1 for formation of the Alliance). For too long the voices of researchers in Europe have not had sufficient impact on proposed research programmes by the European Union. Such contact has, until now, been sporadic and not produced the desired results on research topics and priorities. Our new Alliance aims to give a single, powerful voice to the European biomedical research community, that aims to increase funding and ensure the correct research priorities are given funding across all biomedical disciplines. BOX 1: Formation of the alliance The Biomed Alliance officially formed at a meeting in Brussels in December 2010, consisting of the four founding societies: the European …

Importance measures in risk-informed decision making: Ranking, optimisation and configuration control

This paper describes roles, extensions and applications of importance measures of components and configurations for making risk-informed decisions relevant to system operations, maintenance and safety. Basic importance measures and their relationships are described for independent and mutually exclusive events and for groups of events associated with common cause failures. The roles of importances are described mainly in two groups of activities: (a) ranking safety significance of systems, structures, components and human actions for preventive safety assurance activities, and (b) making decisions about permissible permanent and temporary configurations and allowed configuration times for regulation, technical specifications and for on-line risk monitoring. Criticality importance and sums of criticalities turn out to be appropriate measures for ranking and optimization. Several advantages are pointed out and consistent ranking of pipe segments for in-service inspection is provided as an example. Risk increase factor and its generalization risk gain are most appropriately used to assess corrective priorities and acceptability of a situation when components are already failed or when planning to take one or more components out of service for maintenance. Precise definitions are introduced for multi-failure configurations and it is shown how they can be assessed under uncertainties, in particular when common cause failures or success states may be involved. A general weighted average method is compared to other candidate methods in benchmark cases. It is the preferable method for prediction when a momentary configuration is known or only partially known. Potential applications and optimization of allowed outage times are described. The results show how to generalize and apply various importance measures to ranking and optimization and how to manage configurations in uncertain multi-failure situations.

Enhancing EPC supply chain competitiveness through procurement risk management

This article is intended to provide a risk-based procurement management model. The Procurement Risk Cube (PRC) model originates a systematic approach in the identification of the case-specific risks, their sources, the activities on which they impact and the risk owners. The hierarchical breakdown structure helps data aggregation by simply summing the values of exposure by owner/activity/source, so that establishing a correct intervention priority plan to mitigate downside risks, or to exploit upside risks, becomes easier and more effective. A deep insight into case-specific procurement-related risks is provided by the PRC, which is necessary to improve the understanding of the risks in the supply chain (SC) in order to achieve benefit for the whole SC.

(P2-5) Pre- and in-Hospital Time Delays in Acute Stroke Management in Estonia

BackgroundShort intervals between stroke onset and thrombolysis determine the efficacy of this procedure. Guidelines for stroke management were introduced in 2005 in the West-Tallinn Stroke Centre and in 2008 in the Tallinn Emergency Medical Services. Since 2006, annual joint stroke meetings of pre- and in-hospital staff have been held. These meetings included analysis of time delays of thrombolyzed patients.ObjectiveThe aim of the study was to analyze changes in time delays in acute stroke management and adherence to treatment guidelines.MethodsPre- and in-hospital data of all consecutive ischemic stroke patients who received intravenous thrombolytic therapy were recorded prospectively at the Stroke Centre. Data from the implementation period of thrombolysis (2005–2008 i.e., 1st period) were compared to recent data from 2009 to 01 September 2010 (2nd period). The data from all stroke patients presenting to ambulance services were analyzed separately from 01 September 2009 to 01 September 2010. Recorded procedures were compared to current treatment guidelines.ResultsA total of 115 patients received thrombolysis at the Stroke Centre. The Alarm Centre assigned the correct priority (C, lights and sirens) for 31% of thrombolyzed patients during the 1st period, and for 80% during the 2nd period. The mean time ambulance personnel spent at the home was 20 minutes during both periods. In-hospital door-to-needle time was < 60 minutes in 11% of patients during the 1st period, and in 56% during the 2nd period. Ambulance personnel treated 1,094 stroke patients during the study. All procedures were performed and documented correctly in 10% of visits. The most frequent deviation from guidelines was under-reported values of blood glucose. In 44.7% of patients, an ECG was performed, which is not required by guidelines.ConclusionsAcute stroke management improved significantly. Adherence to recently developed stroke guidelines in the ambulance services must be improved.

Der akute Abdominalschmerz in der Notfallambulanz - ein klinischer Algorithmus für den erwachsenen Patienten

Acute abdominal pain represents the cardinal symptom behind a vast number of possible under-lying causes including several ones that re-quire surgical treatment. It is the most common sur-gical emergency, the most common cause for a surgical consultation in the emergency department and the most common cause for non-trauma related hospital admissions. The golden mis-sion statement is to rapidly identify whether the underlying cause requires an urgent or even immediate surgical intervention. However, behind the same cardinal symptom one may encounter harmless or non-urgent problems. By employing diagnostic means cost effectively and with the aim to avoid unnecessary exposure of the patient to X-rays in mind, the challenge remains to identify patients with an indication for emergency surgery from those who suffer from a less serious condition and thus can be treated conservatively and without any pressure of time. Dealing with such a highly complex decision-making process calls for a clinical algorithm. Many publications are available that have scrutinised the different aspects of the initial assessment and the emergency management of acute abdominal pain. How-ever, the large body of evidence seems to miss articles that describe a formally correct priority- and problem-based approach. Clinical algorithms apply to complex disease states such as acute abdominal pain and translate them into one clearly laid out, logically coordinated and systematic overall process. Our intention is to devel-op such an algorithm to approach acute abdominal pain from the surgeon's point of view. Based on daily practice and with reference to available literature, it is the aim of this study to define a work flow that simply summarises all steps in-volved and defines the required decision process in order to form the intellectual basis for an evidence-based clinical algorithm. The result is illustrated as a first draft of such an evidence-based algorithm to allow emergency evaluation of adult patients with acute abdominal pain.

A quality management system based on fuzzy quality pointers in ISO 9000

Quality Pointers (QPs) definition is a key activity in a Quality Management System (QMS) implementation because with them the Quality Manager (QM) is able to manage production processes and monitoring them in a logic of continuous improvement. With respect to the QPs values the QM can take specific decisions on the actions to improve and to correct these values. Moreover, QM's decisions are related not only to the types of actions, but also to their distribution in a certain time period, assigning their correct priorities. The present paper fronts the problem of corrective actions' priorities through fuzzy sets and related rules, with the aim to avoid the problems related to ambiguous values of certain QPs. The approach has been applied to the main production processes of a firm producing motorboats, in which we have realised a Fuzzy QMS for Non-Conformities (NCs) management, defining an objective way to assign the priorities of actions addressed to resolve the NCs found.

Model for end-stage liver disease (MELD) exception guidelines: Results and recommendations from the MELD exception study group and conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the standard MELD formula

Richard B. Freeman Jr., Robert G. Gish, Ann Harper, Gary L. Davis, John Vierling, Leslie Lieblein, Goran Klintmalm, Jamie Blazek, Robert Hunter, and Jeffrey Punch Division of Transplantation, Department of Surgery, Tufts–New England Medical Center, Boston, MA; Departments of Medicine and Transplantation and the Division of Hepatology and Complex GI, Physicians Foundation, California Pacific Medical Center, San Francisco, CA; United Network for Organ Sharing, Richmond, VA; Baylor Regional Transplant Institute, Baylor University Medical Center, Dallas, TX; Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA; Ochsner Multi-Organ Transplant Center, New Orleans, LA; and Department of Surgery, University of Michigan, Ann Arbor, MI

Mapping and Prioritising Vulnerable Resources in Norway

ABSTRACT Environmental impact assessment (EIA) is the basis for all environmental contingency planning in Norway. Dating back to the early 90s, the tools for assessing the consequences to the environment has continuously been improved. Today the models cover both land based and marine resources. The presentation will focus on a model for identifying land based environmental resources most vulnerable to acute pollution and how to give correct priority to each resource. The model is called MOB. It is primarily intended to be used as a tool when establishing contingency plans for accidental pollution. The model is made independent of the chemical spilled The outcome is a prioritised vulnerability map with simple and easy to understand symbols for each location.

Optimizing router arbitration in point-to-point networks

In this article we introduce and evaluate a method for optimizing the router arbitration policy in point-to-point networks. These networks use multiple high-speed, low-cost routers to rapidly switch data directly between data sources and destinations. We assume that routers use an arbitration algorithm that has the ability to assign different priorities to different links thus controlling the distribution of available bandwidth among channels. We propose an analytical method that allows us to determine the correct priorities for channels so as to achieve fair arbitration thus minimizing latency, increasing throughput and eliminating tree saturation. In our study we used data generated by a simulation tool to validate the proposed analytical model for determining the weights (priorities) of router ports and to evaluate the resulting performance improvements. Link usage statistics were recorded by the simulator for the purpose of performing a detailed investigation on congestion effects particularly tree saturation. The method was applied to the ServerNet™ System Area Network (SAN), developed by Tandem Computers Inc.

A HILBERT TRANSORM APPROACH IN SOURCE IDENTIFICATION VIA MULTIPLE-INPUT SINGLE-OUTPUT MODELING FOR CORRELATED INPUTS

Several approaches can be employed to tackle source/path identification problems via multiple-input single-output modeling. When the measured inputs are correlated to each other, partial coherence function approach can be used in which conditioning of the inputs is performed before calculating the contribution of each input. To ensure that the conditioning analysis is successful, correct priorities of the correlated inputs must be provided first, which can be often resolved based on the assumption of causality between a pair of correlated inputs. The contribution of inputs is frequently assessed in the frequency domain and, furthermore, the priorities of the inputs may be frequency dependent. Here, Hilbert transform approach is employed to determine effectively such priorities in the frequency domain and is then applied to an acoustical system. The results are compared with those by other approaches.

A Goal Programming Method for Generating Priority Vectors

The generation of priority vectors from pairwise comparison information is an integral part of the Analytic Hierarchy Process (AHP). Traditionally, either the right eigenvector method or the logarithmic least squares method have been used. In this paper, a goal programming method (GPM) is presented that has, as its objective, the generation of the priority vector whose associated comparison values are, on average, the closest to the pairwise comparison information provided by the evaluator. The GPM possesses the properties of correctness in the consistent case, comparison order invariance, smoothness, and power invariance. Unlike other methods, it also possesses the additional property that the presence of a single outlier cannot prevent the identification of the correct priority vector. The GPM also has a pair of naturally meaningful consistency indicators that offer the opportunity for empowering the decision maker. The GPM is thus an attractive alternative to other proposed methods.

A Goal Programming Method for Generating Priority Vectors

The generation of priority vectors from pairwise comparison information is an integral part of the Analytic Hierarchy Process (AHP). Traditionally, either the right eigenvector method or the logarithmic least squares method have been used. In this paper, a goal programming method (GPM) is presented that has, as its objective, the generation of the priority vector whose associated comparison values are, on average, the closest to the pairwise comparison information provided by the evaluator. The GPM possesses the properties of correctness in the consistent case, comparison order invariance, smoothness, and power invariance. Unlike other methods, it also possesses the additional property that the presence of a single outlier cannot prevent the identification of the correct priority vector. The GPM also has a pair of naturally meaningful consistency indicators that offer the opportunity for empowering the decision maker. The GPM is thus an attractive alternative to other proposed methods.

EpiMAN: Decision Support System for Contagious Animal Disease Control

Contagious animal disease outbreaks are of great economic importance and, therefore, require rapid identification and eradication. Computerized decision support systems can be of help in the operational management of the outbreak control, e.g. to manage the vast amount of data and to help set the correct priorities. A system is presented (named EpiMAN) which is under development for use in the European Union, and based on one developed in New Zealand. The system consists of a database management system, a geographic information system, simulation models and expert systems. The system can also be used in policy development and as a training and research tool.

Teacher Aides

Rarely has an educational decade seen such dramatic reactions as in the proposal, acceptance and subsequent expansion of the involvement of aides in education. Many different terms are used – usually interchangeably – such as paraprofessionals, auxiliary staff, teacher assistants, etc.The basic rationale was that the aide could free the teacher from the trivial, mundane administrative matters and thus release him for the more ‘professional’ areas of curriculum, programming and implementation. In many schools it is considered essential to distinguish between the professional and the non-professional; and this generally means between the instructional, and the non-instructional. Some leading educators are forcing a reappraisal of this thinking for they feel that the aide can provide significant assistance in the instructional field. And, as time progresses the extent of involvement in the instructional programme will probably increase.Analysis of the argument for and against the employment of aides generally indicates that the employment is validated on educational grounds, whereas it is criticised on personal or administrative grounds. Whilst appreciating that education is concerned at present with the interaction of people with people, it is essential to establish the correct priorities: are teachers more important than the pupils they teach? Is the teacher who has an unfounded reservation because of possible side effects more important than the pupil who can learn more effectively because of the presence of an aide? Obviously the pupil is the prime consideration, because the task is the important thing! However most critics appear to show that the child is not the important factor.

Maintainability Aspects of the Overseas AUTOVON Switching System

Preventive and corrective maintenance, packaging concepts, fault-administration methods, and priorities for trouble reports, considered in the design stages, are assessed. System operation is continually monitored; built-in equipment permits automatic and manual routining of critical functions at predetermined intervals.

Whodunit First?

Occasionally we receive complaints because a paper we have published contains material which is not new and does not make reference to the earlier work. This is indeed unfortunate, since a physicist's principal reward for his achievements is recognition by his colleagues. To see one's own work overlooked and forgotten is a painful experience but it happens often, especially when the subject is theoretical speculations.In order not to hurt anyone else's feelings, I shall cite as an illustration a case of my own experience. In the first paper I ever published I tried to establish empirically that the doublets in atomic spectra obeyed the same relativistic formula that was used by Sommerfeld for x-ray doublets. I did not consider this a mere gamble, but believed that I had made a true contribution. My teacher, Ehrenfest, must have thought differently; but in order not to discourage a young beginner, he made me write a short note which appeared in Die Naturwissenschaften of 9 December 1921. A long paper was published in the then already obscure "Archives N\'eerlandaises des Sciences Exactes et Naturelles," printed in Holland in the French language as if to make sure that almost no one would read it. Ehrenfest also invited me to attend henceforth his famous Wednesday evening colloquia, and to present my paper there.In the fall of 1924 Dirk Coster reported in the colloquium on articles by Land\'e and by Millikan and Bowen. I meekly remarked that I had talked about the very same ideas almost three years earlier. I did not appreciate that in the meantime a considerable amount of new spectroscopic data had been obtained, especially by Millikan, which fully supported the relativistic formula, whereas my guess had been based on totally insufficient evidence. In subsequent papers Land\'e was very kind and mentioned that "indications" for the validity of a relativistic doublet formula were contained in my early note. Millikan was not so generous. Late in 1925 Ehrenfest wrote him about the introduction of electron spin, which finally had furnished a sound basis for the doublet formula, and noted how nice it was that one of the proponents of the spin idea had also been the first to propose that formula. Ehrenfest told me that Millikan had reacted rather unfriendly to this remark, but refused to show me his letter. Thus, it seems to me that in spite of the great changes in physics the attitudes and sensitivity of physicists have not changed in all those years and probably never will.In a book review in this month's Bulletin of the Atomic Scientists, Hedwig Born considers publishing of half-baked ideas unethical, since the author gambles without risking a loss. If his idea is later proven to be correct he claims priority and enhances his reputation; if it is proven false he "offered it only as a hypothesis" and suffers no discredit.Even the best referee cannot always remember every paper in his own specialty. A new discovery or idea will be remembered without difficulty if it is accepted at the time it is announced. As long as it is still merely a suggestion or a speculation, it seldom leaves a lasting impression. In such cases the same "new" idea can be rediscovered several times. The questions arise whether the earlier proponents were far-sighted geniuses or merely lucky guessers and also whether their speculations influenced later work. It is obvious that these questions can rarely be settled objectively. Therefore, in most cases, credit should be granted only when the discoverer has waited until other developments have furnished arguments which make the idea finally acceptable.